MEDICINE AND PUBLIC HEALTH IN THE BRAZILIAN UNIFIED HEALTH SYSTEM (SUS): CHALLENGES TO ACHIEVING EQUITY IN ACCESS AND QUALITY OF CARE

Abstract

This chapter aims to critically analyze the challenges to achieving equity in access and quality of care within the Brazilian Unified Health System (SUS), considering the foundations of social medicine and collective health. The methodology is based on a narrative literature review, integrating theoretical contributions from classical and contemporary scholars such as Cecília Donnangelo, Jairnilson Paim, and Maria Cecília de Souza Minayo, as well as the analysis of normative documents and institutional reports from the Ministry of Health. The results show that, although SUS has made significant progress in expanding access, structural inequalities related to socioeconomic, territorial, and racial factors persist, directly affecting the quality of care. Key barriers include chronic underfunding, fragmented management, precarious health work conditions, and unequal distribution of services and professionals. Furthermore, there is a need to strengthen primary health care as the coordinator of care and to incorporate intersectoral practices addressing social determinants of health. It is concluded that promoting equity in SUS requires not only financial investment but also structural changes in system organization, focusing on comprehensiveness, social participation, and user-centered care practices, aiming to reduce inequities and continuously improve the quality of care.